Outcomes of Revision Hip Arthroscopic Surgery: A Systematic Review and Meta-analysis

O’Connor, Michaela; Gk, Steinl; Padaki, Ajay S.; Duchman, Kyle R.; Rw, Westermann; Ts, Lynch

doi:10.1177/0363546519869671

Cited by 27 publications

(31 citation statements)

References 29 publications

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“…Additionally, at final follow-up, the average mHHS in our cohort was 76.8, which is similar to the value of 74.61 reported in the results of a meta-analysis on RHA by O’Connor et al. 21 Of note, our cohort’s average NAHS at final follow-up was 80.1, within the range of values reported in the literature on RHA (69.00-83.70). 22 , 23 These results suggest that RHA generally has positive implications for patients.…”

Section: Discussionsupporting

confidence: 89%

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Radiographic Factors Associated With Failure of Revision Hip Arthroscopy

Bloom¹,

Yu²,

Kingery³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To identify clinical and radiographic factors associated with failure of revision hip arthroscopy (RHA). Methods A database was used to identify patients who underwent primary hip arthroscopy and revision hip arthroscopy (RHA) from January 2007 to December 2017 for the indication of femoroacetabular impingement and failure of the index procedure, respectively. The primary outcome was defined as the change, or difference, in the preoperative to postoperative alpha angle between patients with successful RHA and those with failed RHA. Failure was defined as reoperation on the operative hip for any indication or a modified Harris Hip Score (mHHS) of less than 70 at the 1-year postoperative time point. All patients had a minimum of 2 years’ follow-up from the date of revision hip surgery. Patients with a history of revision were divided into those with failed revisions and those with successful revisions. The inclusion criteria for failed revision included a history of subsequent revision surgery (or arthroplasty) or an mHHS of less than 70 at final follow-up. Results The study included 26 patients, comprising 8 (31%) with failed RHA and 18 (69%) with successful revision. The failure group showed a significantly smaller decrease in the alpha angle with surgery, measured on the Dunn view, compared with the success group. When the preoperative alpha angle was held constant, each 1° increase in the difference between the preoperative and postoperative alpha angles achieved during surgery was associated with a 17% decrease in the odds of failure. Patients included in the success group had both a higher preoperative mHHS (44.2 ± 8.6 vs 34.7 ± 9.6) and a higher postoperative mHHS (83.2 ± 8.3 vs 62.3 ± 14.2) than patients with failed RHA. There was a statistically significant difference in the frequency of patients who achieved the patient acceptable symptomatic state of +74.0 between the failure (25%) and success (83%) groups; 88% of patients in the failure group met the minimal clinically important difference, whereas 100% of patients in the success group (n = 18) met it. Conclusions Complete resection of cam lesions as determined by changes in the alpha angle, anterior offset, and head-neck ratio when measured on the Dunn 45° view correlates with positive clinical outcomes after RHA. Level of Evidence III, Retrospective Comparative Study.

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Section: Discussionsupporting

confidence: 89%

“…Only 2 patients in our failure cohort (25%) had failure because they underwent revision procedures. O'Connor et al 21 recently reported in a meta-analysis that RHA does indeed result in significant improvements in PROMs but still less than those for primary hip arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Factors Associated With Failure of Revision Hip Arthroscopy

Bloom¹,

Yu²,

Kingery³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Recent studies do show significant improvement in patient-reported outcome (PRO) following revision hip arthroscopy ( 34 , 36 ). A meta-analysis by O'Connor et al ( 37 ) reported a significant improvement in all PRO scores from before operation to the latest follow-up after revision, with the greatest average increase shown in the modified Harris Hip Score (mHHS) (+17.20) and the Hip Outcome Score–Activities of Daily Living (HOS-ADL) (+13.98), and a decrease in the visual analog scale for pain (VAS) (−3.16). Domb et al ( 34 ) reported similar results from a study of 47 revision hip arthroscopies at a mean length of follow-up of 29 months, concluding a statistically significant improvement in each PRO measured: mHHS, HOS-ADL, HOS Sports Subscale (HOS-SS), VAS for pain, and the Non-arthritic Hip Score (NAHS).…”

Section: Discussionmentioning

confidence: 99%

Revision Hip Arthroscopy in the Native Hip: A Review of Contemporary Evaluation and Treatment Options

et al. 2021

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Hip arthroscopy is a reproducible and efficacious procedure for the treatment of femoroacetabular impingement syndrome (FAIS). Despite this efficacy, clinical failures are observed, clinical entities are challenging to treat, and revision hip arthroscopy may be required. The most common cause of symptom recurrence after a hip arthroscopy that leads to a revision arthroscopy is residual cam morphology as a result of inadequate femoral osteochondroplasty and restoration of head–neck offset, though several other revision etiologies including progressive chondral and labral pathologies also exist. In these cases, it is imperative to perform a comprehensive examination to identify the cause of a failed primary arthroscopy as to assess whether or not a revision hip arthroscopy procedure is indicated. When a secondary procedure is indicated, approaches may consist of revision labral repair, complete labral reconstruction, or labral augmentation depending on labral integrity. Gross instability or imaging-based evidence of microinstability may necessitate capsular augmentation or plication. If residual cam or pincer morphology is present, additional resection of the osseous abnormalities may be warranted. This review article discusses indications, the evaluation of patients with residual symptoms after primary hip arthroscopy, and the evaluation of outcomes following revision hip arthroscopy through an evidence-based discussion. We also present a case example of a revision hip arthroscopy procedure to highlight necessary intraoperative techniques during a revision hip arthroscopy.

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“…T he arthroscopic management of focal chondral lesions of the hip has evolved in an attempt to alleviate symptoms and mitigate progressive chondrolabral damage while treating femoroacetabular impingement syndrome (FAIS). [1][2][3] This evolution has included abrasion chondroplasty, 4 microfracture, 5 fibrin adhesive for partly detached acetabular cartilage flaps, 6 mononuclear cell concentrate with platelet-rich plasma, 7 various types of autologous cartilage grafts, [8][9][10][11][12][13] and synthetic matrix substances, 14,15 among other hip preservation techniques. In earlier reports, the underlying surgical principles consistently aimed at debriding the loose cartilage fragments from the defect bed and creating stable margins.…”

mentioning

confidence: 99%

Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique

Lall

Ankem

Diulus

et al. 2021

Arthroscopy Techniques

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Treatment of hip joint chondral damage is a well-recognized aspect of the arthroscopic management of femoroacetabular impingement syndrome. Hip chondral resurfacing has evolved from microfracture to different forms of cartilage grafting, all with variable long-term outcomes. Recent literature has focused on techniques using different cartilage sources (native and synthetic products) that are available for clinicians to choose from during hip arthroscopy. None of the published reports on cartilage grafts have commented on hip joint capsular management as part of the procedure. This is likely because of the increased difficulty of capsular closure in the dry arthroscopic environment required for graft stabilization. However, potential iatrogenic hip instability induced by an unrepaired interportal capsulotomy can be detrimental to the existing joint architecture and possibly to the cartilage graft. This article presents a stepby-step approach, including tips and pearls, for capsular closure during arthroscopic acetabular chondral resurfacing with BioCartilage (Arthrex, Naples, FL). This method is a safe and reproducible way to close the joint capsule during chondral resurfacing in patients undergoing hip preservation that can potentially enhance the chances of a successful outcome.

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Outcomes of Revision Hip Arthroscopic Surgery: A Systematic Review and Meta-analysis

Cited by 27 publications

References 29 publications

Radiographic Factors Associated With Failure of Revision Hip Arthroscopy

Radiographic Factors Associated With Failure of Revision Hip Arthroscopy

Revision Hip Arthroscopy in the Native Hip: A Review of Contemporary Evaluation and Treatment Options

Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique

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